﻿<%@ Page Title="" Language="C#" MasterPageFile="~/Page.Master" AutoEventWireup="true"
    CodeBehind="CMS_AddProfile.aspx.cs" Inherits="_4T.CMS_AddProfile" %>

<%@ Register Src="ASCX/UploadZone.ascx" TagName="UploadZone" TagPrefix="uc2" %>

<asp:Content ID="Content1" ContentPlaceHolderID="MainPlaceHolder" runat="server">
    <script type="text/javascript">
        SetCurrentMenu('liWrite')
    </script>
    <script type="text/javascript">
        function CheckAddProfile() {
            if (document.getElementById("MainPlaceHolder_txtPatientName").value == "") {
                alert("Vui lòng nhập họ tên bệnh nhân");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtDOB").value == "") {
                alert("Vui lòng nhập ngày sinh");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtPermAddr").value == "") {
                alert("Vui lòng nhập địa chỉ");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtMedicalFacility").value == "") {
                alert("Vui lòng nhập cơ sở y tế nơi điều trị");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtDiagnosis").value == "") {
                alert("Vui lòng nhập bệnh án");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtSituation").value == "") {
                alert("Vui lòng nhập nội dung cần hỗ trợ khó khăn");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtSupport").value == "") {
                alert("Vui lòng nhập nội dung cần được hỗ trợ");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtDescription").value == "") {
                alert("Vui lòng nhập diễn tả ngắn gọn về hồ sơ");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtInfoSupplierName").value == "") {
                alert("Vui lòng nhập họ tên người cung cấp");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtCreatedDate").value == "") {
                alert("Vui lòng nhập thời gian đề xuất");
                return false;
            }
            if (document.getElementById("MainPlaceHolder_txtDOB").value == "") {
                alert("Vui lòng nhập ngày sinh");
                return false;
            }
        }
    </script>
    <div class="grid_12">
        <div class="block-border">
            <form class="block-content form add-profile" id="simple_form" method="post" action="" runat="server" enctype="multipart/form-data">
                <h1>Thông tin Hồ sơ</h1>
                <fieldset class="grey-bg">
                    <legend>Thông tin bệnh nhân</legend>

                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Họ tên</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtPatientName" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rp_clear"></div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Giới tính</label>
                        </div>
                        <div class="rp_right">
                            <asp:DropDownList ID="ddlGender" runat="server">
                                <asp:ListItem Value="Male" Text="Nam"></asp:ListItem>
                                <asp:ListItem Value="Female" Text="Nữ"></asp:ListItem>
                            </asp:DropDownList>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Ngày sinh</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtDOB" runat="server" CssClass="full-width datepicker"></asp:TextBox>
                        </div>
                    </div>

                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">CMND</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtIDNumber" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>

                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Địa chỉ thường trú</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtPermAddr" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>

                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Địa chỉ tạm trú</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtTempAddr" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại di động</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtMobileNumber" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại cố định</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtPhoneNumber" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Người đại diện để liên hệ khẩn cấp</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtRepresentativeName" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtRepresentativePhone" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Đầu mối liên hệ ở địa phương</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtLocalContactName" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtLocalContactPhone" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Cán bộ y tế</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtMedicalStaffName" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtMedicalStaffPhone" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Cơ sở y tế đang điều trị</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtMedicalFacility" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Ghi chú khác</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtNote" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>

                <fieldset class="grey-bg">
                    <legend>Thông tin bệnh án</legend>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Chuẩn đoán</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtDiagnosis" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Thời gian mắc bệnh</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtMedicalTime" runat="server" CssClass="full-width datepicker"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Phương pháp cần chữa trị</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtTreatmentMethod" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Hoàn cảnh, khó khăn hiện đang gặp</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtSituation" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Cần hỗ trợ giúp đỡ</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtSupport" runat="server" TextMode="MultiLine" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>
                <fieldset class="grey-bg">
                    <legend>Thông tin người cung cấp</legend>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Họ tên</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtInfoSupplierName" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Số điện thoại</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtInfoSupplierPhone" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                    <%--<div class="rpContain">
					<div class="rp_left"><label for="complex-title" class="required">Mã số</label></div>
					<div class="rp_right"><asp:TextBox ValidationGroup="AddProfile" ID="txtPersonalCode" runat="server" CssClass="full-width"></asp:TextBox><asp:RequiredFieldValidator ID="RequiredFieldValidator16" runat="server" ErrorMessage="*" ToolTip="Trường bắt buộc" ValidationGroup="AddProfile" ControlToValidate="txtPersonalCode"></asp:RequiredFieldValidator></div>
                </div>--%>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title">Email</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtEmail" runat="server" CssClass="full-width"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>

                <fieldset class="grey-bg">
                    <legend>Hình ảnh, video đính kèm</legend>
                    <div class="rpContain">
                        <uc2:UploadZone ID="UploadZone1" runat="server" />
                    </div>
                </fieldset>

                <fieldset class="grey-bg">
                    <legend>Các thông tin khác</legend>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Mô tả ngắn:</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtDescription" runat="server" CssClass="full-width" TextMode="MultiLine"></asp:TextBox>
                        </div>
                    </div>
                    <div class="rpContain">
                        <div class="rp_left">
                            <label for="complex-title" class="required">Thời gian đề xuất:</label>
                        </div>
                        <div class="rp_right">
                            <asp:TextBox ID="txtCreatedDate" runat="server" CssClass="full-width datepicker"></asp:TextBox>
                        </div>
                    </div>
                </fieldset>

                <fieldset class="grey-bg no-margin">
                    <asp:HiddenField runat="server" ID="hdfProfileCode" />
                    <%--<legend>Action on create</legend>--%>
                    <p class="input-with-button">
                        <%--<label for="simple-action">Select action</label>
					<select name="simple-action" id="simple-action">
						<option value="1">Save and publish</option>
						<option value="2">Save only</option>
					</select>--%>
                        <asp:Button ID="btnSave" runat="server" Text="Lưu" CssClass="big-button" OnClick="btnSave_Click" OnClientClick="return CheckAddProfile()" />
                        <%--<button type="button">Create</button>--%>
                    </p>
                </fieldset>

            </form>
        </div>
    </div>
</asp:Content>
